Lipid management across Europe in the real-world setting: a rapid evidence review

Abstract

Objective

To provide a contemporary overview of recent real-world lipid-lowering therapy (LLT) practices and outcomes in patients with hypercholesterolemia/dyslipidemia at high/very high risk of atherosclerotic cardiovascular disease in Europe.

Methods

A structured literature review of recent (July 2015–July 2020) real-world studies reporting lipid management and outcomes was conducted using a rapid evidence synthesis. Outcomes included patient characteristics, LLT treatment practices, adherence and low-density lipoprotein cholesterol (LDL-C) goal attainment.

Results

Fifty-three real-world observational studies in high/very high risk patients were selected after screening 5664 records (n = 50 national [sample size range 38–237,279] and n = 3 multinational studies [sample size range 6648–8456]). Mean age ranged from 33 to 77 years; hypertension, diabetes and obesity were commonly reported comorbidities. Statins were the most common LLT; patients without familial hypercholesterolemia (FH) mostly received high or moderate intensity statins/LLT, while patients with FH mostly received high intensity statins/LLT. The proportion of patients receiving ezetimibe was low overall (ezetimibe + statin use in those with and without familial hypercholesterolemia [FH] range 5%–59% and 1%–22%, respectively). Overall, the use of proprotein convertase subtilisin/kexin 9 inhibitor (PCSK9i) therapy was limited. Adherence to LLT therapies was defined variably and ranged from 46%–92%. LDL-C goal attainment was suboptimal, irrespective of LLT (overall range in goal attainment with oral LLT was 2%–73% [FH: 2%–23%] and with PCSK9i was 20%–65%).

Conclusions

LDL-C control is suboptimal and the available LLT armamentarium, most importantly combination therapy, is being underutilized in high/very high risk patients leading to inadequate management of cardiovascular risk.

Keywords:

• Dyslipidemia
• cardiovascular disease
• lipid management
• literature review
• low-density lipoprotein cholesterol
• real-world evidence

Transparency

Declaration of funding

This literature review was funded by Daiichi Sankyo Europe GmbH.

Author contributions

V.B. was involved in interpretation of the data, critical revision of the manuscript for important intellectual content and approval of the final version. A.A. and J.S. were involved in study design, interpretation of the data, critical revision of the manuscript for important intellectual content and approval of the final version. A.M.C. was involved in extraction, synthesis and interpretation of the data, drafting and revision of the manuscript and approval of the final version. All authors agree to be accountable for the work.

Declaration of financial/other relationships

V.B. has disclosed that he has received consultancy and/or lecturing fees from: Almirall, Amgen, Daiichi Sankyo, MSD, Rovi, Sanofi and Viatris. A.A. and J.S. have disclosed that they are employees of Daiichi Sankyo Europe GmbH. A.M.C. has disclosed that she is an employee of Open VIE Ltd (doing business as Open Health).

Acknowledgements

Medical writing support for this literature review and manuscript was provided by Open VIE Ltd, doing business as Open Health (Kavitha Baruah and Nick Spencer), funded by Daiichi Sankyo Europe GmbH. The authors thank Aikaterini Bilitou from Daiichi Sankyo Europe GmbH for advice and contributions to the revision of this manuscript.